Approved Contractor Scheme

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Section A - To be completed by all applicants

It is important this section is completed by a person in your company who has access and authority to all information.

Type Of Work

1.0 Company

Please give details of any Parent Company and attach a list of associate companies and organisation structure.

Trading Name

Address

Postcode

Telephone No

Fax No

Email Address

Internet Address

2.0 Group

All following questions relate to the Supplier making this application.

Parent Company Name

Address

Postcode

Telephone No

Fax No

Email Address

Internet Address

3.0 Registered Office

Trading Name

Address

Postcode

Telephone No

Fax No

Email Address

Internet Address

4.0 Contacts

Please give name, position, telephone no, fax no and email address (if different from office above). Please also provide details of parent company as stated above.

Operational

Financial

Health and Safety

5.0 Financial

Bank Account Number

Sort Code

Company Registration No

VAT No

Type of Company

Turnover for past 3 years This information is needed so that you can be fairly assessed in relation to the size of your business

6.0 Insurance

Please attach copies of certificates or proof of premium payment.

Employers Liability

Amount Minimum £10 million

Insurer

Policy No

Expiry Date

Business Activities Covered

Exemptions

Please attach copies of certificates or proof of premium payment

Public Liability

NB. Subcontractors insurances to be aligned to this cover

Amount Minimum £10 million

Insurer

Policy No

Expiry Date

Business Activities Covered

Exemptions

Please attach copies of certificates or proof of premium payment

Professional Indemnity (if applicable)

Amount

Insurer

Policy No

Expiry Date

Business Activities Covered

Exemptions

Please attach copies of certificates or proof of premium payment

7.0 Professional Accreditation

Please give detail of any membership of professional or trade organisations Provide copies of current membership or accreditation certificates.

8.0 General

How long has the company been trading?

Has the company traded under any other names? If YES please give reason for the change(s)

Are there any claims or actions current or pending against the company?

Services Offered

Geographical areas of operation

Typical recent projects

Recent Project 1

Client

Period

Total Value

Project

Recent Project 2

Client

Period

Total Value

Project

Please supply your most recent client list and contact details

Please provide details of any formal notices that have been issued or legal proceedings that have been taken against your company by any person or company in the last three years

9.0 References

Please provide two companies you have current contracts with whom we may approach for confidential references.

Company 1

Company Name

Address

Postcode

Telephone No

Fax No

Email Address

Business Relationship

Period of Relationship

Company 2

Company Name

Address

Postcode

Telephone No

Fax No

Email Address

Business Relationship

Period of Relationship

Who is your largest client and what % of your turnover do they represent?

10.0 Environment

Do you have an environmental policy , statement or report?

Attached files

Are you accredited to or working towards an environmental policy, statement or Management System (e.g. ISO 14001)?

Attached files

Do you carry out staff environmental awareness training?

Attached files

Do you reduce, reuse and recycle where possible?

Attached files

Do you include any environmental criteria in your purchasing decisions?

Attached files

Do you assess your supplier's products on their environmental performance?

Attached files

Please briefly list any environmental, waste or energy saving projects that you are or have been involved with?

Attached files

11.0 Quality Management

Do you have a Quality Management System? If so please give details

Attached files

Do you have a Quality Manager? If YES please state his/her name

Do you have a Quality Improvement Programme?

Do you pre-qualify your employees and/or sub-contractors?

Do you manage your subcontractor's quality and performance? If YES, please provide evidence of a successful vetting exercise that you have undertaken on a sub-contractor. The vetting exercise must include all documentation received from the sub-contractor and must be for a sub-contractor you have deemed competent. Provide details of your arrangements for vetting of contractors: this should form part of your health and safety policy arrangements.

Has your company been awarded Investor in People status? If so, please give the date

12.0 Security

Does your company operate vetting procedures in line with Security Industry Standards (BS 7858)?

Please provide details of relevant security vetting procedures

Attached files

13.0 Human Resources

Do you have a training policy?

Attached files

Do you recognise trade unions?

What is your staff turnover rate %?

Please give the number of directly employed employees in your company

Please give the number of directly subcontracted employees in your company

Does your company have a staff dress code? If YES please give details

Please supply a company organisational chart

Describe your company's recruitment policy. Detail the sources you would use and experience, if any for recruiting

What would be the main selection criteria you would apply?

Attached files

Please provide a brief outline of your induction procedures for new staff and training/health and safety procedures for existing staff

Attached files

Please supply brief details as to the appraisal systems for staff stating how often they are carried out and by whom

Attached files

Does your company have a staff motivation scheme in place? If so, please provide details

Attached files

14.0 Qualification Statements

Describe what steps you would take in the preparation on start up of an Agreement including details of the following: Recruitment, Training, Implementation, Client Introductions, Business Needs. What lead time do you require?

15.0 Additional Supporting Information

Additional

16.0 Disaster Recovery Plan

Do you have a disaster recovery plan in place? If so please provide details

Attached files

Section B - To be completed by all applicants

It is important this section is completed by a person in your company who has an understanding of your health and safety management.

1.0 The Management of Health and Safety

State the name of the person acting as your competent health and safty adviser as required by regulation 7 of the Management of Health and safety Welfare Regulations 1999

Describe their (Health and Safety) qualifications

Attached files

Provide the competency details of the source of advice including a CV and evidence of competence e.g copies of certificates/professional memberships.

If you do not have access to competent health and safety advice, please describe how you obtain health and safety advice/information

Please describe how health and safety management responsibilities are devolved within your company

Please attach a document showing your organisation for health and safety (duties and responsibilities, etc)

You must include with your submission a copy of your company's health and safety (duties and responsibilities). Your arrangements or procedures for carrying out the policy - i.e. risk assessment, COSHH, manual handling procedures , safety procedures, safety manuals, etc.

Please attach your health and safety policy statement (or statement of intent)

Although you are not legally required to have your health and safety policy and arrangements in writing it is good practice to do so as you must still be able to demonstrate your commitment to health and safety and management of it to a potential client. Provide a copy if you have one including a signed statement of intent, a responsibilities section and an arrangements section.

If you do not have a written H&S Policy, please confirm how you communicate company policies and procedures to your employees.

Describe how your policy is brought to the attention of employees

Describe how your company undertakes formal reviews of Health and Safety Performance

Attached files

You must attach an example of completed workplace inspection used in your offices workshops or work sites in support of this question.

Who undertakes monitoring and inspections?

Please attach your arrangements for health and safety (risk, COSHH, manual handling and other procedural document, safety manuals, handbooks, guidance notes, codes of practice, etc)

Accident Reporting

Please describe your accident reporting and investigation procedures

Who is responsible for reporting accidents and dangerous occurrences, etc to the HSE or Appropriate Authority?

Please provide your last three years accident figures

Year 1

Year Ending

Fatal

Major Injury or Over 3-Day

Non-Reportable

Year 2

Year Ending

Fatal

Major Injury or Over 3-Day

Non-Reportable

Year 3

Year Ending

Fatal

Major Injury or Over 3-Day

Non-Reportable

Please provide full details of any enforcement notices or prosecutions served on your company in the last three years by the HSE or Local Authority

Describe what actions your company has taken as a result of any actions taken against your company

3.0 Sub-Contractor Safety

If your company employs sub-contractors please describe what process or procedures you use to determine their health and safety competency

Who is responsible for ensuring the sub-contractor is health and safety competent?

Does this person work directly for your company? Yes No

Please attach your competency assessment procedure and a worked example of an assessment

4.0 Site Health and Safety

Outline the procedure your company has established to be followed if serious danger were to arise on site or in the workplace

Describe your arrangements for ensuring satisfactory liaison and co-operation between your site operative and the client or other contractors.

5.0 Risk Assessment

You must attach worked examples of risk assessments completed by or for your company within the last three years. (This should include COSHH, manual handling, noise, working at height, working in confined spaces, fire risk assessment, working with machines, electrical equipment, etc.) One example should show non-routine emergency actions and the implications for others such as contractors, visitors, clients, etc.

What arrangements does your company have for carrying out assessments, implementing actions and informing staff of control measures? The examples provided must be specific to a job that your company has undertaken. Model assessements are not acceptable unless there is a clear evidence of how they have been applied to a job.

State who undertakes these assessments and what specific training if any they have received for risk assessment

Please attach the following:

These examples must be specific to work undertaken by your company.

Three worked examples of model risk assessments

One fire risk assessment applicable to your office or workshop

One site based fire risk assessment (where applicable)

Two examples, where applicable, of COSHH assessments on substances used by your company that are covered by these refulations

Two worked examples of manual handling assessment (where applicable)

One worked example of a Work at Height assessment

6.0 Training

State who is responsible for implementing training needs in your company

Describe all health and safety training you have provided to your managers and employees over the last year

Please attach examples of employee's health and safety training records for a selection of managers and employees. This should include details of the training providers.

Please state whether or not the following types or training are provided for your employees

Health and Safety Induction Yes No

Asbestos Awareness (where appropriate) Yes No

Hazard Awareness and reporting Procedures Yes No

Accident Reporting Yes No

Training identified by the risk assessment process Yes No

Give details of the system your company has to identify any health and safety training needs not covered in the paragraph above

Provide details of course content and training provider

Please provide details of other current accreditation / assessments you may have undergone for health and safety

7.0 Associations or Memberships

Is your company a member of any trade association? (e.g. CITB, NBC, etc) Please provide the association names and your membership numbers.

Is your company a member of a Health and Safety organisation such as RoSPA or the British Safety council? If yes, please give details

Is your company registered with any Skills Registration Scheme or equivalent? Please provide full details along with the number of employees that hold the valid skill registration cards or equivalent

Health Surveillance

Describe (if applicable) your company's arrangements for providing satisfactory health surveillance for your employees

Declaration

I declare the information provided in this form is a true and accurate statement of the company's health and safety procedures and no statement made is intended to misrepresent the company's commitment to health and safety.

Name

Appointment

Company

Tel

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